Microbial Infections and Antimicrobial Use in Neonates and Infants

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: 31 July 2024 | Viewed by 4763

Special Issue Editor


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Guest Editor
Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, 27100 Pavia, Italy
Interests: infectious diseases; congenital infections; neonate; intensive care
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Special Issue Information

Dear Colleagues,

Despite the important technological advances and the improvement in the level of care, which have led to a significant increase in survival among neonates, infections/sepsis are still in third place for prevalence, incidence, and cause of death among newborns.  The importance of focusing attention on the microbial infections in the neonatal population is therefore evident. The goal of the Special Issue entitled “Microbial Infections and Antimicrobial Use in neonates and infants” is to compile an up-to-date collection of original research and review articles related to clinical presentation, diagnostic challenges, and treatment of various microbial infections, as well different aspects of antimicrobial use, such as antibiotic stewardship and pharmacodynamics/pharmacokinetic of antimicrobials in neonates.

Dr. Chryssoula Tzialla
Guest Editor

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Keywords

  • microbial infections
  • antibiotics
  • neonate
  • infants
  • antimicrobials

Published Papers (4 papers)

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Research

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13 pages, 756 KiB  
Article
Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US
by Robin B. Dail, Kayla C. Everhart, Victor Iskersky, Weili Chang, Kimberley Fisher, Karen Warren, Heidi J. Steflik and James W. Hardin
Trop. Med. Infect. Dis. 2024, 9(4), 70; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed9040070 - 28 Mar 2024
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Abstract
Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of [...] Read more.
Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. Methods: 367 preterms born at <32 weeks gestational age (GA) between 2019–2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics. Results: The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). Conclusions: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs. Full article
(This article belongs to the Special Issue Microbial Infections and Antimicrobial Use in Neonates and Infants)
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14 pages, 1130 KiB  
Article
Sustaining the Continued Effectiveness of an Antimicrobial Stewardship Program in Preterm Infants
by Tommaso Zini, Francesca Miselli, Chiara D’Esposito, Lucia Fidanza, Riccardo Cuoghi Costantini, Lucia Corso, Sofia Mazzotti, Cecilia Rossi, Eugenio Spaggiari, Katia Rossi, Licia Lugli, Luca Bedetti and Alberto Berardi
Trop. Med. Infect. Dis. 2024, 9(3), 59; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed9030059 - 7 Mar 2024
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Abstract
Background: There are wide variations in antibiotic use in neonatal intensive care units (NICUs). Limited data are available on antimicrobial stewardship (AS) programs and long-term maintenance of AS interventions in preterm very-low-birth-weight (VLBW) infants. Methods: We extended a single-centre observational study carried out [...] Read more.
Background: There are wide variations in antibiotic use in neonatal intensive care units (NICUs). Limited data are available on antimicrobial stewardship (AS) programs and long-term maintenance of AS interventions in preterm very-low-birth-weight (VLBW) infants. Methods: We extended a single-centre observational study carried out in an Italian NICU. Three periods were compared: I. “baseline” (2011–2012), II. “intervention” (2016–2017), and III. “maintenance” (2020–2021). Intensive training of medical and nursing staff on AS occurred between periods I and II. AS protocols and algorithms were maintained and implemented between periods II and III. Results: There were 111, 119, and 100 VLBW infants in periods I, II, and III, respectively. In the “intervention period”, there was a reduction in antibiotic use, reported as days of antibiotic therapy per 1000 patient days (215 vs. 302, p < 0.01). In the “maintenance period”, the number of culture-proven sepsis increased. Nevertheless, antibiotic exposure of uninfected VLBW infants was lower, while no sepsis-related deaths occurred. Our restriction was mostly directed at shortening antibiotic regimens with a policy of 48 h rule-out sepsis (median days of early empiric antibiotics: 6 vs. 3 vs. 2 in periods I, II, and III, respectively, p < 0.001). Moreover, antibiotics administered for so-called culture-negative sepsis were reduced (22% vs. 11% vs. 6%, p = 0.002), especially in infants with a birth weight between 1000 and 1499 g. Conclusions: AS is feasible in preterm VLBW infants, and antibiotic use can be safely reduced. AS interventions, namely, the shortening of antibiotic courses in uninfected infants, can be sustained over time with periodic clinical audits and daily discussion of antimicrobial therapies among staff members. Full article
(This article belongs to the Special Issue Microbial Infections and Antimicrobial Use in Neonates and Infants)
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Review

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12 pages, 486 KiB  
Review
Candidiasis in Pregnancy: Relevant Aspects of the Pathology for the Mother and the Fetus and Therapeutic Strategies
by Alessandro Messina, Alessia Mariani, Romina Brandolisio, Elena Tavella, Chiara Germano, Giovanni Lipari, Livio Leo, Bianca Masturzo and Paolo Manzoni
Trop. Med. Infect. Dis. 2024, 9(5), 114; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed9050114 - 15 May 2024
Viewed by 578
Abstract
Vulvovaginal candidiasis (VVC) is a common condition that can lead to significant discomfort, affecting approximately 70–75% of women at least once in their lives. During pregnancy, the prevalence of VVC is estimated to be around 20%, peaking at about 30% in the third [...] Read more.
Vulvovaginal candidiasis (VVC) is a common condition that can lead to significant discomfort, affecting approximately 70–75% of women at least once in their lives. During pregnancy, the prevalence of VVC is estimated to be around 20%, peaking at about 30% in the third trimester, with a number of specific risk factors predisposing to yeast infection being identified and needing elucidation. This review aims to provide updated knowledge on candidiasis during pregnancy, addressing risk factors and maternal and neonatal outcomes, as well as discussing optimal therapeutic strategies to safeguard mothers and newborns. The bibliographic search involved two biomedical databases, PubMed and Embase, without imposing time limits. Among all Candida spp., Candida albicans remains the most frequent causative species. The hyperestrogenic environment of the vaginal mucosa and reduced immune defenses, physiological effects of pregnancy, create conditions favorable for Candida spp. vaginal colonization and hence VVC. Recent evidence shows an association between VVC and adverse obstetric outcomes, including premature membrane rupture (PROM), chorioamnionitis, preterm birth, and puerperal infections. Prompt and effective management of this condition is therefore crucial to prevent adverse obstetric outcomes, maternal–fetal transmission, and neonatal disease. Additional studies are required to confirm the benefits of systemic treatment for maternal candida infection or colonization in preventing premature birth or neonatal systemic candidiasis. Full article
(This article belongs to the Special Issue Microbial Infections and Antimicrobial Use in Neonates and Infants)
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17 pages, 623 KiB  
Review
Stop in Time: How to Reduce Unnecessary Antibiotics in Newborns with Late-Onset Sepsis in Neonatal Intensive Care
by Domenico Umberto De Rose, Maria Paola Ronchetti, Alessandra Santisi, Paola Bernaschi, Ludovica Martini, Ottavia Porzio, Andrea Dotta and Cinzia Auriti
Trop. Med. Infect. Dis. 2024, 9(3), 63; https://0-doi-org.brum.beds.ac.uk/10.3390/tropicalmed9030063 - 19 Mar 2024
Viewed by 1385
Abstract
The fear of missing sepsis episodes in neonates frequently leads to indiscriminate use of antibiotics, and prescription program optimization is suggested for reducing this inappropriate usage. While different authors have studied how to reduce antibiotic overprescription in the case of early onset sepsis [...] Read more.
The fear of missing sepsis episodes in neonates frequently leads to indiscriminate use of antibiotics, and prescription program optimization is suggested for reducing this inappropriate usage. While different authors have studied how to reduce antibiotic overprescription in the case of early onset sepsis episodes, with different approaches being available, less is known about late-onset sepsis episodes. Biomarkers (such as C-reactive protein, procalcitonin, interleukin-6 and 8, and presepsin) can play a crucial role in the prompt diagnosis of late-onset sepsis, but their role in antimicrobial stewardship should be further studied, given that different factors can influence their levels and newborns can be subjected to prolonged therapy if their levels are expected to return to zero. To date, procalcitonin has the best evidence of performance in this sense, as extrapolated from research on early onset cases, but more studies and protocols for biomarker-guided antibiotic stewardship are needed. Blood cultures (BCs) are considered the gold standard for the diagnosis of sepsis: positive BC rates in neonatal sepsis workups have been reported as low, implying that the majority of treated neonates may receive unneeded drugs. New identification methods can increase the accuracy of BCs and guide antibiotic de-escalation. To date, after 36–48 h, if BCs are negative and the baby is clinically stable, antibiotics should be stopped. In this narrative review, we provide a summary of current knowledge on the optimum approach to reduce antibiotic pressure in late-onset sepsis in neonates. Full article
(This article belongs to the Special Issue Microbial Infections and Antimicrobial Use in Neonates and Infants)
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